Neurasthenia

Shenjing shuairuo (神经衰弱), often translated in English as neurasthenia, has been made
famous by Arthur Kleinman (1981, 1986) as the Chinese version of
major depressive disorder. It is commonly said of Asian
cultures, and in fact of most non-Western cultures generally, that
they encourage somatization -- the process of experiencing
and expressing emotional stressors and mental illness through bodily
complaints. (Another way of describing this is to say that
Westerners tend to psychologize their symptoms and to experience and
to express their complaints in a psychological rather than somatic
idiom.)

Neurasthenia was created as a diagnostic category in the
19th-century United States by a neurologist, George Beard (Kleinman,
1988:100). 19th-century "neurology" was not based on the same
conceptions of biology held by modern neurology and neuroscience.
It seems in some cases to have operated on a quasi-humoral theory of
"vital energy" in which diseases were caused by "exhaustion" of the
"nerves". Often it provided biological explanations for existing
psychiatric syndromes, as in the case of neurasthenia for
depression, or anorexia nervosa for hysteria.
This reduced the stigma of the illness, and allowed respectable
members of the middle- and upper-classes to be treated in
respectable offices by respectable physicians rather than by
alienists in asyla. Finally, exhaustion of the nerves served as a
mark of status, since elites were considered more vulnerable to such
ailments, in the way that ulcers or hypertension may serve as
markers of elite status today.

The concept of neurasthenia was introduced to the Chinese medical
establishment along with the rest of Western medicine, and it seems
to have been enthusiastically adopted. According to Kleinman
(1981:258-259) neurasthenia is the second most common diagnosis in
Chinese psychiatric hospitals, and one of the most common
neuropsychological diagnoses in general. Neurasthenia seems to
subsume a number of indigenous terms: shen2jing1 shuai1ruo4
or (WG) shen-ch'ing shuai-jo; huo3qi4 da4 or (WG)
huo-ch'i ta "excessive hot internal energy", a syndrome of
irritability, anger, and anxiety, along with gastrointestinal
complaints; and sim1 chap8-chap8 (Taiwan) a syndrome of
chest pains and palpitations with anxiety; and shenkui (discussed
elswhere) are all used to express what would probably be
diagnosed as major depressive disorder or anxiety
disorder in the West.

A typical case study of neurasthenia follows:

One patient was a 41-year-old man with headaches, pains in joints,
insomnia, "too many dreams", loss of appetite, weakness, and the
belief that there was something wrong with his brain that caused his
scalp to sweat excessively. It seemed to us this patient had a
depressive syndrome associated with a fixed idea, which could have
been a somatic delusion. In treating him, the doctor diagnosed a
skin disease of the scalp which he claimed would improve the scalp
problem and through it the patient's "brain function". That in turn
would cure the depression. In the entire exchange doctor and
patient discussed illness and treatment solely in somatic terms.

The puzzle of neurasthenia in China is of how to reconcile it
with Western diagnostic categories. The World Health Organization's
manual ICD-10 classification of mental and behavioural
disorders (1992:170-171) still recognizes neurasthenia as a
diagnosis:

either persistent or distressing complaints of increased
fatigue after mental effort, or persistent and distressing
complaints of bodily weakness and exhaustion after minimal effort;

at least two of the following: feelings of muscular aches
and pains; dizziness; tension headaches; sleep disturbance;
inability to relax; irritability; dyspepsia;

any autonomic or depressive symptoms present are not
sufficiently persistent and severe to fulfill the criteria for any
of the more specific disorders in this classification.

Includes: fatigue syndrome.

These criteria emphasize the phenomenology of exhaustion,
inability to concentrate, and general bodily complaints, all of
which typically occur in Western patients with depression. Kleinman
seems to believe that Chinese neurasthenia and various similar
Chinese syndromes mentioned above are variants manifestation of
major depression or anxiety disorders; however, he also wants to
maintain the specificity of the Chinese situation. Many of the
neurasthenic patients examined by Kleinman are survivors of the
Cultural Revolution, a social upheaval which utterly transformed
Chinese society. In Kleinman's view, to gloss over the specific
socially experienced trauma of the Cultural Revolution, to pass
lightly over the particular subjectivity of the Chinese neurasthenic
embedded in a complex web of family, Maoism, and traditional Chinese
philosophy, would be to ignore what is important about the Chinese
experience of neurasthenia as distinct from Western depression.

Works on neurasthenia in China include:

Kleinman, Arthur. (1986) Social Origins of Stress
and Disease: depression, neurasthenia, and pain in modern China
New Haven: Yale University Press.